Journal Articles about the CHIP Program

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"Effects of an intensive diet and physical activity modification program on the health risks of adults"

Journal of the American Dietetic Association

March 2005 • Volume 105 • Number 3:371-381

Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Merrill RM, Ohmine S, Thomas C

College of Health and Human Performance, Brigham Young University, Provo, UT 84602-2214, USA. steve_aldana@byu.edu

BACKGROUND:

This study assessed the clinical impact of lifestyle change education on chronic disease risk factors within a community.

DESIGN:

Randomized clinical trial.

SETTING/PARTICIPANTS:

Participants included 337 volunteers age 43 to 81 years from the Rockford, IL, metropolitan area.

INTERVENTION:

The intervention group attended a 40-hour educational course delivered over a 4-week period. Participants learned the importance of making healthful lifestyle choices and how to make improvements in nutrition and physical activity.

MAIN OUTCOME MEASURES:

Changes in health knowledge, nutrition, and physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 weeks.

RESULTS:

Beneficial mean changes in scores tended to be significant for the intervention group but not for the control group. Variables with improved scores included health knowledge, percent body fat, total steps per week, and most nutrition variables. Clinical improvements were seen in resting heart rate, total cholesterol, low-density lipoprotein cholesterol, and systolic and diastolic blood pressure. The control group experienced comparatively small but significant improvements in health knowledge, systolic and diastolic blood pressure, glucose, and in some nutrition variables. For almost all variables, the intervention group showed significantly greater improvements.

CONCLUSIONS:

This lifestyle modification program is an efficacious nutrition and physical activity intervention in the short term and has the potential to dramatically reduce the risks associated with common chronic diseases in the long term.

PMID: 15746824 [PubMed - indexed for MEDLINE]

"The Behavioral and Clinical Effects of Therapeutic Lifestyle Change on Middle-aged Adults"

Preventing Chronic Disease

January 2006 • Volume 3, No.1:A05-17

Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Merrill RM, Ohmine S, Thomas C.

274 SFH, College of Health and Human Performance, Brigham Young University, Provo, UT 84602-2214, USA. steve_aldana@byu.edu

INTRODUCTION:

Chronic diseases such as cancer, cardiovascular disease, stroke, and diabetes are responsible for most deaths in the United States. Lifestyle factors--poor nutrition, sedentary living, and tobacco use--appear to play a prominent role in the development of many chronic diseases. This study determined the behavioral and clinical impact of a therapeutic lifestyle-modification intervention on a group of community volunteers.

METHODS:

Participants included 348 volunteers aged 24 to 81 years from the Rockford, Ill, metropolitan area who participated in a randomized clinical trial. The intervention group attended a 40-hour educational course delivered as lectures during a 4-week period. Participants learned the importance of making better lifestyle choices and how to make improvements in nutrition and physical activity. Changes in nutrition, physical activity behavior, and several chronic disease risk factors were assessed at baseline and 6 months.

RESULTS:

Intervention participants showed significant 6-month improvement in all nutrition and physical activity measures except calories from protein and whole-grain servings and all clinical measures except blood glucose, total cholesterol, triglycerides, and high-sensitivity C-reactive protein. Total cholesterol and low-density lipoprotein cholesterol were worse after 6 months in both groups but only significantly worse in the control group. The control group experienced small but significant improvements in systolic and diastolic blood pressure and high-density lipoproteins. Change-score comparisons between the intervention and control groups were significant for all nutrition and physical activity variables except total steps per week and daily sodium intake and were also significant for the clinical measures of weight, body fat, and body mass index.

CONCLUSION:

This therapeutic lifestyle-modification program can significantly improve nutrition and physical activity behavior and can reduce many of the risk factors associated with common chronic diseases.

PMID: 16356358 [PubMed - indexed for MEDLINE]

PMCID: PMC1500954

"The Effect of a Community-based Coronary Risk Reduction: the Rockford CHIP"

Preventive Medicine

June 2007; 44(6):513-9

Englert A, Greenlaw RL, Diehl HA, Willich SN, Aldana SG

OBJECTIVE:

The aim of this study was to assess the clinical effects of a community-based lifestyle intervention program in reducing coronary risk, especially in a high risk group.

METHOD:

The 40-hour educational curriculum of the Coronary Health Improvement Project (CHIP) delivered over a 30-day period with clinical and nutritional assessments before and after was offered in the spring and fall of 2000 to 2002 through the Center for Complementary Medicine of the Swedish American Health System in Rockford, Illinois to its employees and the general public. The participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 min/day).

RESULTS:

The data of the 5 CHIP programs were pooled and analyzed. 544 men and 973 women (almost all Caucasian; mean age 55 years) were eligible for analysis. At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk.

CONCLUSION:

Well-designed community-based intervention programs can improve lifestyle choices and health habits. They can also markedly and rather quickly reduce the level of coronary risk factors in a non-randomized population.

PMID: 17383717 [PubMed - indexed for MEDLINE]

"The Effects of an Intensive Lifestyle Modification Program on Sleep and Stress Disorders"

Journal of Nutrition Health Aging

May 2007, 11(3):242-248

Merrill RM, Aldana SG, Greenlaw RL, Diehl HA, Salberg A

College of Health and Human Performance, Brigham Young University, Provo, UT 84602-2214, Italy. Ray_Merrill@byu.edu

BACKGROUND:

To determine if a lifestyle change program can modify behavior to reduce sleep and stress disorders.

METHODS:

Analyses are based on 2,624 individuals aged 30 to 80 years from the Rockford, Illinois metropolitan area who completed a lifestyle evaluation at baseline and again after four weeks, following participation in a 40-hour educational course given over a four-week period. Participants receive instruction on the importance of making better lifestyle choices related to making long-term improvements in nutrition and physical activity and they learn ways to improve sleep and reduce stress in their lives.

RESULTS:

Significant percent decreases were observed in the number experiencing selected sleep or stress disorders from baseline to four weeks later for "sleeps restlessly" (-59%), "suffers from insomnia" (-64%), "feels under pressure" (-37%), "easily emotionally upset" (-52%), and "feels fearful or depressed" (-61%). Experiencing a selected sleep or stress disorder after four weeks among those who had the disorder at baseline was significantly more likely in those not physically active and/or not having lowered their BMI after four weeks. Changes in alcohol consumption and smoking did not significantly contribute to changes in the disorders. Those who failed to lower their coffee/tea use after four weeks were significantly more likely to have a sleep disorder and be easily emotionally upset.

CONCLUSIONS:

Changes in lifestyle behaviors after attending an educational program significantly reduced sleep and stress disorders in as little as four weeks, primarily explained by decreasing BMI and/or increasing exercise.

PMID: 17508101 [PubMed - indexed for MEDLINE]

"A Video-based Lifestyle Intervention and Changes in Coronary Risk"

Health Education Research

2008 February; 23(1):115-24. Epub 2007 Mar 8.

Aldana S, Greenlaw RL, Diehl HA, Merrill RM, Salberg A, Englert H

Department of Exercise Sciences, 274 SFH, Brigham Young University, Provo, UT 84602-2214, USA. steve_aldana@byu.edu

If population-wide improvements in nutrition and physical activity behavior are to be made, behavior change interventions must use a variety of media. This study examines whether participation in a facilitator-based video version of the Coronary Health Improvement Project could significantly reduce coronary risk. A total of 28 video classes conducted in worksite, medical and community settings were used to teach 763 middle-aged adults, ages 30-79 years, about healthy lifestyles. Four to 8 weeks after baseline, follow-up measures were taken. Demographic and biometric data [body weight, body mass index (BMI), blood lipids, blood pressure and fasting blood glucose] were gathered. The class participants were evaluated in aggregate and showed significant improvements in body weight, BMI, resting heart rate, total cholesterol, low-density lipoprotein, triglycerides and fasting blood glucose. Males demonstrated greater improvement than females, and individuals with higher baseline health risks experienced the greatest reductions in risk. This video lifestyle change program appears to help participants make important lifestyle changes. For individuals empowered to make better choices regarding diet and exercise, significant improvements occurred in most coronary risk factors in as little as 4-6 weeks.

PMID: 17347525 [PubMed - indexed for MEDLINE]

Can Newly Acquired Healthy Behaviors persist?

An Analysis of Health Behavior Decay

Centers for Disease Control and Prevention

January 2008 • Volume 5, No.1

Merrill RM, Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Englert H

Department of Health Science, College of Health and Human Performance, Brigham Young University, 229-A Richards Bldg, Provo, UT 84602-2214, USA. Ray_Merrill@byu.edu

INTRODUCTION:

We evaluated data from the Coronary Health Improvement Project (CHIP) to determine whether improved health behaviors associated with this intervention persisted or decayed during 18 months of follow-up.

METHODS:

Participants were 348 volunteers aged 24 to 81 years from the Rockford, Illinois, metropolitan area enrolled in CHIP, a 4-week educational course delivered as lectures. The intervention taught the importance of making better lifestyle choices and improving dietary and physical activity behaviors. Physical activity and dietary behaviors were assessed at baseline, and changes in behaviors were assessed at 6 weeks and 18 months. Changes were evaluated according to quartile groupings of each variable at baseline.

RESULTS:

No baseline differences were found between participants who dropped out and participants who provided data through 18 months. Mean changes significantly improved through 6 weeks for each of the 21 selected physical activity and dietary behavior variables except percentage of daily calories from carbohydrates. Mean changes significantly improved through 18 months for each of the 21 variables except calories from protein, alcohol, and whole grain servings. The percentage of participants who improved their physical or dietary behavior at 6 weeks ranged from 49% for percentage of daily calories from carbohydrates (64% at 18 months) to 91% for intake of dietary cholesterol per day (84% at 18 months). The level of change through 18 months for all variables was significantly influenced by quartile groupings at baseline. Physical activity improved significantly through 18 months only for participants in the lowest two quartiles of physical activity at baseline. Exercise decreased significantly through 18 months for participants in the highest quartile of physical activity at baseline.

CONCLUSION:

During an 18-month period, participants' physical activity and dietary behaviors improved significantly. Even though behavior improvement tended to be greater at 6 weeks, most healthy behaviors did not return to baseline levels after 18 months.

PMID: 18082002 [PubMed - indexed for MEDLINE]

"C-reactive Protein Levels According to Physical Activity and Body Weight for Participants in the Coronary Health Improvement Project"

Preventive Medicine

Merrill RM, Massey MT, Aldana SG, Greenlaw RL, Diehl HA, Salberg A

Brigham Young University, Department of Health Science, 229-A Richards Building, Provo, Utah 84604, USA.

OBJECTIVES.:

To identify whether the Coronary Health Improvement Project (CHIP), an intervention designed to increase physical activity and improve diet, lowers serum C-reactive protein (CRP). The study will also assess whether changes in CRP over the study period are associated with baseline levels of and changes in selected coronary risk factors.

METHODS.:

A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a 4-week period, beginning March 2003, in Rockford, IL, USA.

RESULTS:

The intervention significantly increased physical activity and decreased BMI, weight, percent body fat, and saturated fat (P<0.0001). However, the intervention was not significantly associated with a decrease in CRP. Participants in both the intervention and control groups combined showed a decrease in high CRP (>3 mg/L), from 46% at baseline to 38% at 6 weeks and 41% at 6 months. Those with higher BMI at baseline showed a greater increase in CRP over time (P<0.0001), whereas those with higher CRP at baseline showed a greater decrease in CRP over time (P<0.0001). CONCLUSIONS: Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. However, the percentage with high CRP did fall, more so for those with lower BMI and higher CRP at baseline. BMI may mediate the influence of physical activity on CRP.

PMID: 18178245 [PubMed - as supplied by publisher]

"The Effects of a Worksite Chronic Disease Prevention Program"

Journal of Occupational Environmental Medicine

June 2005 • Volume 47• Number 6:558-564

Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Merrill RM, Ohmine S

College of Health and Human Performance, Brigham Young University, Provo, Utah 84602-2214, USA. steve_aldana@byu.edu

OBJECTIVE:

This study determined the behavioral and clinical impact of a worksite chronic disease prevention program.

METHODS:

Working adults participated in randomized clinical trial of an intensive lifestyle intervention. Nutrition and physical activity behavior and several chronic disease risk factors were assessed at baseline, 6 weeks, and 6 months.

RESULTS:

Cognitive understanding of the requirements for a healthy lifestyle increased at the end of the program. Program participants significantly improved their cognitive understanding of good nutrition and physical activity and had significantly better nutrition and physical activity behavior at both 6 weeks and 6 months. Participants had significantly lower body fat, blood pressure, and cholesterol.

CONCLUSIONS:

This worksite chronic disease prevention program can significantly increase health knowledge, can improve nutrition and physical activity, and can improve many employee health risks in the short term.

PMID: 15951715 [PubMed - indexed for MEDLINE]

"Rationale & Design of the Rockford CHIP, a community-based coronary risk reduction program: Results of a pilot phase"

Preventive Medicine

April 2004, 38:4, 432-441

Englert H, Greenlaw RL, Diehl HA

Department of Biomedical Sciences, College of Medicine at Rockford, University of Illinois, Rockford, IL 61107, USA. heike.englert@charite.de

PURPOSE:

While residential lifestyle intervention programs have demonstrated coronary risk reduction through education, diet, and exercise, this pilot study was designed to assess the feasibility of a community-based lifestyle intervention program that is both affordable and effective in facilitating better lifestyle choices and health habits and thus effecting indicators of better clinical outcomes.

MATERIALS AND METHODS:

A 40-h educational curriculum, delivered over a 30-day period with clinical and nutritional assessments before and after, was offered through the SwedishAmerican Center for Complementary Medicine to the general public. The participants were instructed to exercise 30 min/day and to embrace a more optimal diet (ad libitum) of largely unrefined plant foods high in complex carbohydrates and fiber, yet quite low in fat (<15%), animal protein, sugar, and salt, and virtually free of cholesterol.

RESULTS:

Of the 250 enrollees, 242 "graduated" (78 men and 164 women; almost all Caucasian; mean age 54 +/- 12 years). They had coronary artery disease (CAD) (12%), diabetes (16%), hypertension (55%), most were overweight (88%), and the majority (79%) had low-density lipoprotein (LDL) levels >or=100 mg%. At 4 weeks, stratified analyses of total cholesterol (TC), LDL, triglycerides (TG), blood glucose, blood pressure, and weight showed that those at highest risk also had the greatest improvements. Depending on baseline levels, TC means dropped 10-23% in men and 6-13% in women. At the same time, LDL means declined 5-30% in men and 6-14% in women. In TG, the biggest drop (48%) was found in men who at baseline were in the highest risk category (in women, the biggest TG drop was 32%).

CONCLUSION:

Community-based intervention strategies can be successfully and affordably utilized to lower coronary risk factor levels in a self-selected, free-living population. The true test, however, will be to what extent social infrastructures can be modified and alumni activities sustained to facilitate long-term adherence and sustained benefits.

PMID: 15020176 [PubMed - indexed for MEDLINE]

Nutrition Action

Center for Science in the Public Interest, Oct. 2005 ,Michael F. Jacobson, PhD
"Saving 400 at a Time"
To Read this article click here